Public Health, Welfare and Labor- House & Senate

Kate chairs these a quorum we're we're gonna go ahead and get started we've got a long agenda hopefully will be able to get out by noon but yeah a lot of rules on the agenda. But before we get started. We have a couple things we wanted to get out of the way here that looks that's not really on the agenda. Of first off I want to thank Senator Cecile Bledsoe for all the years that she served on public health this will be your last meeting Cecile summit mo some you all may know this most of your news I am and don't but Cecile has been here in Little Rock twenty years she took a recess for a while but came back but twenty years total and I think she told me she'd been on public health for sixteen of those years. So I appreciate your commitment to public health and all the work to do for the state so. Thank you so much it's been a pleasure and to I'm certainly leaving it in good hands I look forward to all the wonderful things that to the Committee will do and I just wish you well thank you so much thank you. All right since we're in that vein. we're also losing another member of our team up here of Phil price is going to be retiring at the end of December. And Phil's been around actually longer than Cecile hassle so feel we appreciate all the work that you've done for public health and and for the legislature and and I was surprised when I started looking at all the things that you've done and different committees that you worked on your. Spread yourself around here and and done a good job and so I've got a letter here that a I want to read and give to you sums gonna read this to you you Mr price congratulations on forty years of dedicated service to the state of Arkansas and specifically to the public health welfare and labor committee your unmatched commitment as the staff person for the health insurance marketplace legislative oversight committee health reform task force judicial committees and transportation committees are commendable that appreciated your proficiency and success with the bureau of legislative research led you to serve in multiple designations including special advisory committee staff for the Arkansas Legislative Council the developer the developer of State welfare and workforce investment legislation an administrator for committee staff services and a senior legislative analyst the title service you provided to the legislators state agencies and constituents was vital to the Arkansas General Assembly as flow of work your professionalism and expertise never faltered and for that we're grateful you will truly be missed by all who have worked with you throughout the years again congratulations and thank you for your invaluable expertise and French Hill the public health welfare and labor committee wish you the very best during your will serve retirement sundeck Ladyman chairman. Thank. All right now I want to ask my coach here Senator Bledsoe as she has any comments. Thank you so much yes I have a letter also Mr price's been a tremendous asset to this community and to our body in many different areas but he's especially one of my favorites because he helped train me. So I have this letter not only for me but so far from the senators that serve on this committee do Mr price let me take this opportunity to thank you for your exceptional work and professionalism as the legislative analyst for the Senate and house public health welfare and labor committees and as a legislative staffer for the arc from the for the Arkansas General Assembly you've been a tremendous asset to the committee leadership and both of the full committees your resourcefulness knowledge support preparation in integrity set you apart is a professional and as an individual you truly have devoted their talents to the various research organizational and committee meeting needs with care and consistency your brand of professionalism and grace is difficult to find in will be hard to replace I have no doubt you have left a lasting impression on your colleagues throughout the years and are to be commended for your investment in Arkansas for your state service it's is citizens like you who helped build strong cohesive and collaborative workplaces across start across our state that can benefit all or can since I joined the leadership and staff of the bureau of legislative research your colleagues family and friends in extending my gratitude to you for your committee extraordinary contributions to our state legislature it it's been an honor to work with you all these years I hope you're looking forward to enjoying your retirement plans in this new season of life and I hope you can take this time to fully experience the parts of life you love most congratulations again on your outstanding Sir. This and may you continue to be richly blessed in all your future endeavors sincerely Cecile Bledsoe assistant pro team and a chair of the Senate public health committee thank you so much. You know I really I feel like a youngster up here forty years twenty years I've only been here six or eight years I forget but we're not done yet we'll get one more thing. Of course that letter was for me but it represented other folks in the house as well but we have another gift for you for helping us with the house public health committee. So. A representative Ferguson has something or if you want. Yeah. Contributed to this but we also got to go back because we know you're going to be your retirement is going to see your daughter and yeah I just feel you're just as my dad had a fine person I just I mean I just love you know you check the department of public health and with the insurance benefits I mean I don't know what I would have done the last ten years. No bill Sanderson postcards we are using that language okay. All right we'll move on to our business now Item C. is next on the agenda consideration to adopt the November seventh minutes that motion. The second column favor say aye. All opposed nay lotion carries minister adopted. One item D.. Review of the Arkansas tobacco settlement commission quarterly report for January through March twenty twenty two. So if you all would come to the table. If you would please introduce yourself and who you represent. Good morning Matt Gilmore department health. I'm Bobbie McGee I'm the dean of the graduate school professor you MSN executive director of Arkansas about sizes and state. Emily lane with UCAM the project director for the evaluation team. A man I think you can talk about the report and have a presentation. You're recognized. Thank you Matt Mr chairman chair committee thank you for times when a you got a long agenda as well keep this as brief as possible but I do appreciate your time this morning I would like to go the report just in some. Some brief comments there and then turn it over to the committee to talk about the Arkansas by science institute. This report of a jammed from before the tobacco settlement commission programs is for a January through March of this year if you remember back that was when the Omicron variant was in the state and a lot of cases I think at one point we had over a hundred thousand active cases the states a lot of the different things we typically report on from year to year quarter to quarter or impacted by that but we've seen improvements since then a couple things I will point out though that increased and we're positive was the number of screens that were done in this quarter that was an increase compared to this time period for the last year that was a positive there and then also point out the number of healthcare professionals that were educated and students during this time frame we saw increase there as well one more thing I'll point out and that's related to the Medicaid expansion programs with tobacco settlement dollars the population or in a are seniors program increased and I think that's a positive there for that population those folks are served with additional needs there through the Medicaid program I think we'll see that public populations can change the services provided there as the public health emergency it in all that is on the federal level that that you know continues or ends we'll see some changes there and in the future but that's kind of just a very brief overview of some things I want to point out in there but I want to say most of the time the document here he has a lot of different things that is programs across the state engage in as far as research working with a judge different educational institutions and some entities as well so I'll be happy to provide more information take questions if you have those but I'd like to turn over documents you know could. All right thank you a committee any questions on the report. The C. nine and the presentation and I think I had requested some of the organizations that are funded through this program to be here and they're here today to present that so the Arkansas biosciences so you're you're recognized to present thank you Mr chairman and and I don't have a power point but I've given you a copy of our annual report for this year which is R. twenty S. and I've got some sort of talking points might ask me if I give a brief overview and then talk specifically about a couple of projects but I do once first off of the committee this committee for over twenty years as a as of a spectator or representing the AB I had been coming for several years and and the one the first year that I was asked to speak I got up here we were across the street in my Mike when working and Mister price came forward he'll never remember this he came for government might go on and everything and and I said thank you senator Propst expert or crappies that I'm not a legislator they don't know how to work this way. Is it really put me at least for the very first time I ever spoke at this and and Senator Bledsoe you've long been an advocate for the tobacco settlement commission we will miss you and certainly in particular for the Arkansas biosciences thank you very much. So this is a this could not happen better for me this is our twentieth anniversary of the tobacco settlement commission we highlighted that in our annual report that I hope each of you got you should have gotten again here please feel free to share that I was really really honored to be able to interview at the same time former governors might be be of Mike Huckabee and and document that in our report I think it's really empty it was such an amazing saying that occurred with the initiated act and the amazing support that we received from all of our governors and all of the legislators over the last twenty years we continue to be the only state in the country the worst part of the master settlement agreement that uses one hundred percent of this money for research and health it's really a testament when we hear so much about Arkansas not being on top of everything we are here and it's really nice so in your hand out I'll just be using this sort of as talking points but on the you know we are a consortium and this is all mandated and as specified in the Act but the five members are the University of Arkansas for medical sciences Arkansas children's research institute Arkansas state university of the university of Arkansas and the that fable in the University of Arkansas division system division of agriculture those are the five entities that of the money each year goes to and we use that for a whole host of things that have been highlighted in over twenty years worth of of annual reports on the left you'll see this is this is a pretty impressive number but we the FBI of roughly gets about ten million dollars a year from the tobacco settlement over the twenty years we have use that to leverage eight hundred and sixteen million dollars and extramural awards that's not including the money that came from maybe that's all in extramural awards from outside of the State. we've averaged over over those twenty years over two hundred sixty investigators three hundred full time research jobs we've had over seventy five hundred publications and our overall twenty year return on investment was four dollars and fifty cents for every dollar that we receive. This past year alone which really is why we have these quarterly meetings of we had a banner year this year despite covid and you know lots of things being suppressed we had we what we got sixteen sixty seven million dollars our award this year was uh ten point eight million from the settlement it was one of our highest ever return on investments of six dollars and nineteen cents for each dollar that was received again that's not the A. B. I. dollars that we receive is the extramural dollars in the last year and a half we recruited to the state thirty new A. B. I. investigators we've got two hundred fifty full time resource jobs in this year alone we had three hundred and seventy nine publications and you may or may not remember last year's report but we committed to COVID the Arkansas biosciences a student are five members all had massive community contributions to the Arkansas department of health and other organizations and the response to code and we highlighted that in those and would be happy to talk about some of those if you would like. with that I'd like to a man asked me if I'd just speak about a couple of projects and I thought I'd come to go to from one extreme to the other of what we kind of cover and you can think about everything in between there and we're doing that as well but the one of the things that I think was a real highlight this year was this Arkansas state university national student payload opportunity was citizen science it's called the Spock's. After a the famous Star Trek character but this was a competition that started out with several hundred NASA eliminated a limited it many of them got it down to about twenty they may have to ten and then they selected five and as you can see in the bullet points here's some of these five that were selected included Columbia Stanford New Hampshire in Idaho there were many other places that of renowned that we're competitors as well but it was really quite amazing so they decide to this experiment that was placed on it I think they had three different of sort of scuttles before they actually launched on July the fifteenth but it was a if it received a lot of national attention and as one of the five it was really a pretty cool experiment of the very multi disciplinary there was electrical engineering biology mechanical engineering this is all done under the guidance of doctor Maureen Dolan a professor who's been highlighted in our report many times over the past twenty years of and you can see the title it's a little bit intimidating microgravity environment impact on plastic bio degradation by Galeria Melanella which is wax worms. But the but the bottom line is residue and debris and waste in space as well as on this planet our problem and and what they did is they they discovered that this wax worm has the capability of digesting polyethylene which is in most plastics so what they did is they actually set this this this little pod with these wax worms and a substrate of plastic to see how well it would work in space with the idea being that maybe it would be a way of contributing to waste management in space and it was really it worked and they're now that you know they've gotten the pot back and they're now working on the now system hopefully to be publishing that soon if you would like I'd be more happy to come in when they get the final analysis done in the tell you have worked really really of a very cool thing if you think about how few activities actually get into space. The next I want to talk about very and I'll and I'll be brief but this is one that I'm really really proud of and this is something and I think that you all should be as well because. This is why we do a lot of the things that we do and this is a really. Nice collaboration between the all payer claims database which many of you here helped initiate I think now about ten twelve years ago and is done through the Arkansas center for health improvement under the direction of Joe Thompson of the Arkansas insurance department which works very closely with a cat and in getting the APCD an Arkansas biosciences institute so thank I has this massive database that is used by the state and is is an incredible resource it's also very expensive to maintain. And but what it really is from my point of view of a scientist is a treasure trove that is almost priceless there are there are databases like these and an analogous to it around the country access to them is very expensive sometimes of of say a three or four year grant may have allotted as much as sometimes two hundred thousand dollars just to get access to these kinds of databases so what we did with this sort of tripartite collaboration and developed imho you with with was to allow a beyond vested Gators access to this for helping offset so with an annual all set to help pay for the cost of maintaining this this database this started five years ago in two thousand seventeen and I'm happy to say that today we've got forty seven approved projects that have come out of that collaboration it's ongoing in fact you know I the A. B. also has its own board of directors that I respond report to in addition to all of you but we the R. board of directors just approved it for another five years so I'm really excited about that already we've got two hundred and thirty seven investigators and we've gotten over two million dollars in extramural funding and over twenty publications and you know when the sum of the numbers of tossed around that doesn't sound like that much but these things take time so we've only had the collaboration for five years you know it takes a year to get everything set up a year to get your policy Jack done a year to now analyze it apply for extramural funds so at this early stage really it for half years to have extramural funds coming in and publications coming out it's really a testament and. I can tell you that no other state does this anywhere so it's just been a absolutely fabulous collaboration one I think the entire station to take great pride in and that's the end of my summary I'd be glad to answer any kind of questions that you might have and thank you very very much for the opportunity to do this and and represent labor when you ask for someone to give you a report I told Pat I said put me up Is. Thank you for that report I think we've got a few questions but I wanna make a comment on this is real interesting to me specially this amass a program and a little bit of a side Comment here and then this is not negative towards this but I happen to be watching Scooby doo yesterday with my grandsons. And there was a new cartoon that Scooby doo came out with and it was the science competition and the the scientist on the Scooby doo team up like a names well or what the the smart one she won the competition against these other people and her project was effective gravity on earth worms in space well it was just exactly what you talked about in the one of the opponents talk about where you Senator worms in the space you know what's that got to do with things in course she being the science on the team gave a very good answer about how it affects humans or it could affect humans so that was national attention I like Scooby doo lot of people probably do. But I thought that was on when you talk about that thank you representative of Ferguson Jett questions. Hello thank you thank you Mr chairman of first of all I wanted to applaud when you said Arkansas spent a hundred percent of their tax settlement healthcare related things because I just went to a conference in nationwide only three percent of the money is sent spent by states directly related to health care to back at us so that's great. But I am on the S. the same question I ask every year and really don't seem to get the answer that I like we've done a great job of reducing smoking overall we've had a little increase obviously with the vaping but we in in Medicaid populations which we pay for the healthcare we have really not reduce smoking at all hardly I mean just very minimally what are we doing to actually reduce tobacco use in low income populations. Thank you representative Ferguson up that is a struggle with that population we have the the will of center the department of health that you know we reach out and it's available for anyone to call in it I think it does Cervelo income let's give that that population group. Overall I think the state smoking rate has decreased I can get you some information on the Medicaid population if possible because we pull there but since I've been working with the commission and the department of health I think we were I think around twenty five percent of the population in Alberta and around twenty so I think we're moving the right direction around that population is a struggle I think there's been some things a child in the legislature working with pharmacist able to provide certain types of. treatment for that for that Medicaid would pay for think that's helped as well but as far as the population itself out I agree to be more improvement there and will continue looking out for opportunities and ways to do that and I'll get you the latest data on that but as far as you know anything particular just for that population things all done opening up where pharmacists can provide some of those treatments B. will quit line as well and that helps but there's room for improvement. Yes I mean the other thing I hear from public health officials official nationally is that. They're selling discounted tobacco products to that really target these communities are we doing anything to prevent those kind of a commercial endeavors from really targeting low income population with discounted products and what are we doing it certainly affects childhood asking are we doing anything to directly address the problems with childhood asthma and in in those homes. Yep so with the smoking and and certain communities and that sort of thing I think one thing we've seen is menthol is is primarily seems to be in those types of communities where you've got low income individuals that seem to be easier product for them to use our sub grantees try to work in those communities and educate through their grantees to their programs they do in the in the local areas and then also working with the retailers making sure that they the tobacco control board the FAA working with them to make sure that those retailers are held to the same standard as far as what how they advertise and as far as their inspections and that sort of thing as far as child as may I get some information on that I'm not aware of the things particularly that we're doing specifically tobacco settlement for that but I need some information on the. A committee any other questions. well Dr McGee I think it is a great accomplishment that we're spending hundreds of that money result may not show it but we're putting the money in the right place I think that is a great accomplishment. All right without objection this report is reviewed thank you for your comments. Okay we'll move on to item II. A review of the annual summary report of the vision screenings in Arkansas public and charter schools for the year twenty twenty one and twenty twenty two so if you all would come to the table. And please introduce yourself and who you represent. Good morning I'm sure remake Donald I service the state school nurse consultant for the department of education. You're recognized to present your. This is the twenty twenty one twenty two vision summary report for school age children in Arkansas and this report basically includes the number of children screen the number children followed up and are referred and then the number of children followed up with a little bit more data only twenty eight percent of the children who had follow up only twenty eight percent of those children had follow up and of those twenty eight percent ninety percent were identified to have some kind of complications such as maybe needing lenses or other I disorder that was maybe recognized and so the opportunity to screen children allows for us to be able to identify the problems at an early age and then hopefully to have children and be able to have a comprehensive eye exam. So. That's really it's pretty laid out there that that is there at the if anyone has any questions I'll be more than happy to answer. When I was interested in the number of the twenty eight percent that actually showed up that was referred. I mean is there any reason why they don't go to that referral D. A. V. I. comments. On that I don't have you know date in hand on that they're speculation there's also what school nurses say or often provide information on and that is the fact that access to care is not always easily available especially in some of the rule areas for children to go so some of our children in lower. Poverty levels have some difficulty to be able to for parents to take off to be able to provide also and I think I've said this in the past to this committee is that often it's the last thing on the to do list of a parent because it doesn't necessarily hurt and it doesn't you're not necessarily six so sometimes that's the last thing it gets taken care of. The only committee idea what percent of those shows are in rule or CIS cities I mean you know have any idea about that now we have a broken down on the my school info and desi webpage of the different schools that show some of that is duplicated data and the data that I provide for you all is unduplicated meaning they take out the students that may have moved from one school to another but you can find that information to see in your area what kids the number being again screen followed up and those that referring followed up. Thank you. any questions from committee. Without objection this report is reviewed thank you thank you. Okay moving on we're going to. Yeah item if is been pulled down David cook has the flu couldn't be here so we're going to pull it down but without objection I want to move items the. Up to the top of the list here. So items Z. as the status of electronic waste program. So I'd like to call a Mr Philip Cole if you're here and then. So if you if you all would done. Introduce yourself and and who you represent. I'm Philip coal and I'm the manager of TSS marketing redistribution okay. And I'm Lauren Ballard I'm interim chief legal with that the Department transformation church services okay. And we were requested to put this on the agenda just to have a discussion about what's going on with the E. waste you all handle and there was a of a law that was passed I think last session maybe so if you want to just go ahead and present what you have there okay Sir of the new law that was passed is there going they want to take all electronic the we get into marketing redistribution and they want to send it to a. Private companies to refurbish in resale and currently we still that those computers and anything else electronic we rarely have any with the waste at all and last year in are sold nine hundred and seventeen thousand dollars worth of electronic and of that money of course we're self funded Sir and we kept our fee which is one of the three hundred out little over three hundred thousand the agency's got back three hundred thousand and there's a special fund eighty Q. has that every time we sell something we have to give them twenty five percent of it and they get to two hundred twenty nine thousand. And if we go through this this money won't will not come back to the state. Two for us to use it the way it we've been using the agencies use the money to do whatever they want used for and since we're self funded up by my salaries in my. insurance fuel and everything else. Know what department are you under but state department. Transformation church services transformation. All right so. This. E. waste that is now going outside that you're not selling what percent of your income is that the you know. Well based on last year's it was right at thirty percent of my income. Okay. So you're aware that I mean that's a law that says you have to send it to him yes I would soon they picked this up eight your location is that correct Sir I'm sorry the company that is handling this now picks it up at your location yesterday with the rats what they wanna do they want to start this in January okay. So this is not been done not yes okay. All right. We've got a couple questions let me let me go to questions right now a representative Gonzalez you're recognized for a question thank you Mr this maybe a question for staff for you what what the bill was this that it was written that let me let me recognize representative when can you address that. the C. that would've been Senate bill five eighty five I believe that was senator Wallace is bill I carried it in the house and the the purpose of this bill as intended was to create and you waste program that if the state of Arkansas participated it would guarantee that it would be solvent for the rest of the state as well to be able to participate in this E. waste program the time it was passed we didn't hear any opposition at all to this in fact this is the first that we have heard of it not not not say they were not sympathetic to your concerns however year and a half ago when this bill is passed would have been the time for this to have been able to be brought before so that we can work out any Kinks in this so that that's what the bill was and the twenty twenty one regular session it was passed in I believe was April of of twenty twenty one was one that was passed. The representative when the you know I mean this would benefit all the ways districts throughout the state that correct that is correct they would re process this and the money would be distributed to all of state waste districts is what I understand Zacharek yeah well with the what this bill did was by the state of Arkansas participating in the ways program just the ways that we knew that you waste that would come out of just the government offices would be able to fund the program and allow it to be sustained for the rest of the state so that we wouldn't operated a cost to the state of Arkansas taxpayers. I want to ask the microgrid Pavey would come up to the table I had a question for him. Please include your self in the represent my cover page department of environment. Mr mail all I want to ask you was do you know how this funding is distributed or can you put some light on that how this money is distributor goes back to the districts or actually I don't believe there was any money that was going to be distributed I think that if you included all of the E. way from the state. It would cover the cost of the other districts that had anyways program continued their program there the truth pick up that cost. I don't think there was any money flowing back and forth is just this service would be provided for free to the districts okay nine. All right thank you. Of. Representative Gonzalez did you have a question. Yes thank you Mr so. At the point this goes through the Them in our it is it actually waste then if it has a value in your reselling it does it have to go to this program or can you cannot continue to sell those products. If I may represented Gonzales I think one of the and. Hurdles that were trying to jump through at an in seeing this act and trying to to make it work and the definition of of consumer electronic devices provided for in the bill and we have a little bit of a question that I would I'll let Philip answer on what is actually E. waste my understanding is most of what goes through in our is actually resold so I do not believe he sent anything to a landfill but I'm let me answer that question. Notion when it comes to us we so long as individual pieces of electronics back to different entities in the state and to the public we get lots of computers we lock him up and we sell them as a lot and we do not have anything that I consider you wish now that being said I will say that some of the for reaching different parts of the state like if they have one or two piece of electronics in it would be cost prohibitive to go pick that up then we allow them to take that to any will waste for soccer but this limited. Okay so I'm not real familiar with this bill at all I was trying to sit here scanned through it so why would those items have to go into this program to be picked up and recycled if they have you can be resolved and seem to be laced what's the two things I representative Gonzalez and the first is that you have in on our initial reading the definition again we have a little bit trouble understanding though I agree that we're saying anyways but then there's a definition in that bill for consumer electronic device so for us to follow that the language of that bill it would be items other than just what you and I might strictly think of the waste the other thing I want to point out and and for the you know benefit of the body as well there was an electronic solid waste management's bill passed back in two thousand one General Assembly thinking about this for a long time so that's the other at thread will need or having a threat is that there's another statute that actually sets out some requirements on marketing redistribution for handling E. waste and state agencies actually state supported entities on handling E. waste so we're cognizant about and some other portions of the code that for instance you of certain entities property become by those laptops are you know be that as it may. But I tend to agree I I don't you know I I just I certainly don't think the Department renter's insurance services. Want to be city waste landfills by any means but I think the way that that bill was written it encompasses items that could be sold. By. Thank you. Representative we can add what what we're talking about with the U. S. as we're not putting it in the landfills what what has happened is that any of the the E. waste while the represents only a small portion of what goes into landfills it does represent a very significant portion of the hazardous waste in landfills and so what the attempt of this bills to do is to help solidify that you waste programs of the marketability of the waste can be capitalized for the benefit of the state of Arkansas because we do have yeah there's a there's benefit in some of the older the way systems that we have but also to keep it out of just getting trashed and put into landfills and so that that's the goal of this program is to be able to capitalize on the marketability of it and keep it out of the landfills as well. So we say you waste it's not like we're saying we're throwing it away we're actually basically recycling at. Representative Gonzalez recognized. I thank Mr so so. Reserving is there a problem with how how it's been how it's being done is is is something that we need to change or can we change this definition to where they can continue to do what they're doing to benefiting the state agencies with that money or. Yes what the attempt to hear was that we knew that the state of Arkansas with all of the entities that we have throughout the state had significant amounts of E. waste in fact to the tune of nine hundred thousand dollars a year and so we wanted to put together a statewide initiative that can with just the the foundation level of funding from the state of Arkansas would be enough to stay in a statewide program so what's been happening so far to this point has been just within state government but now with the state of Arkansas lending its resources of the massive amounts of the ways that we have per year now we can encourage everyone in the State of Arkansas to participate in some participate in this program it would be self funded and it would broaden its effect to be able to help decrease the waste that comes from private entities now with the sustainability of what we're doing here in the state it helps expand that keep the waste out also marketable for everybody else as well okay yeah I was thinking and and state not the product coming in as well yeah I think the bill in the intent and and it sounds like it would be successful the issue here is we did the unintended consequences it affected a state agency that we have we we didn't realize that so Mr Cole if this if you start sending this E. waste off like the law says. How will that affect your operation well the well was explains Mr chairman is they would still require us to go pick the stuff up and bring it back to my warehouse and stored until I got a box truck load of the and then they would come pick it up which would be I would have paid my salaries everything like that and I would be not I wouldn't be getting any return on investment of my time and and resources. So would you be able to continue to operate at the level you are now would you the funding what what what what what would fix that. Just if we could get more other stuff that we can sales or I mean it it's all based on what comes in okay. Well I think the intent was just to get the problem out here let everybody have a chance to ask questions about it and see were at sea we find solutions to your problem thank you so other any other questions. Seeing none thank thank you all for being here thank you Sir. Okay we'll go G.. All right a committee within the item G. DHS has many rules to present here so when Adam G. John come to the table. Division county operations. Please introduce yourself and who you represent. Thank western more quiet secretary department services. Larry Crutchfield Division of County operations. Gross page Department of Human Services to see Medicaid policy administrator. You're recognized to present your rule. We are presenting rule alone Medicaid and snap changes Realart read please make related to the office of child support enforcement and streamlining some of our policy the proposed rule streamlines the process for providing accurate information to the office of child support enforcement regarding absent parents for a Medicaid or snap applicant or recipient. Really what this is what this does is it allows the department to sanction an individual without sending them to CSE if they indicate that they do not intend to cooperate with child support and they do not have a good calls so what it really does is allows the case workers out in the field to make that decision that if they have no intentions of cooperating with child support they can apply the section on the front end and not send that business process sanction back overdose CSE and wait for them to send something back to the agency and then for the agency to take action. And that's that's the basically the not sell this rule. So did you get any comments we did on a public hearing up I do have a question just curiosity question. One of. on that snap sixteen twenty three dot three dot one it removes the word guardian why why was that done. Sixteen twenty three three that's one dot one. It says parent and guardian and you removed the RDS. I'm just curious what what was at nine. I believe that the I might get back to you on that I think I know the answer but I don't think it's forget related related to the father regulations that were under and I think it's implied it's and it is amputation there so I don't think it changes of the impact or the reach of the law but is not necessary as it relates to a mandatory a child support enforcement program like we have in Arkansas but I will get that back to you so you don't think it restricts eight guardian's ability to. To work with snap I mean does it restrict the guardian does not okay if you send me something. With any other questions. See now without objection this rule stands as review thank you. Okay we're gonna we'll move on to item H.. Division of Medical Services. Please introduce yourself and who you represent. Good morning Elizabeth admin I Division of Medical Services. You're recognized. What today will bring forward a rule on cost sharing for both the our home population and for the traditional fee for service population as you know we discovered we were not in compliance with the CMS regulations on the fee for service side and so we did cut off cost sharing last year this rule does bring us into compliance with CMS regulations for fee for service and implement our home cost sharing under the new waiver and happy to take any questions on. Any questions from committee. Seeing none without objection this rule stands review. So you're recognized for item I. Which is division of aging adult and behavioral health services. Please introduce yourself and who you represent. Morning M. J. held when the Director phrase you don't have health. John. John Finkbeiner Davis our system director division of aging you're recognized to present your rule thank you. Thank you we're presenting a rule to a proposed a name removal process from the don't know treatment registry is managed within our division. Of the. We were we bring this rule forward to really for a couple purposes one we do have other registries that our houses are Human Services and there are name removal process for those other registries this would simply allow this registry that is maintained within our division to be congruent with the other rule or the other processes that we have it the agency And we did receive some public comments on the rule we did have a question regarding are child maltreatment registry which was shared with the recognition Martin and several comments from the attorney general's office which were agreeable to agency we were able to work those in to the rules to the to the proposal this morning and those are primarily around persons who would die of it was run the prohibitions for individuals who could apply for name removal particularly if there were ongoing criminal charges or if there's cases were still open or pending. But you were able to address all the concerns. Yes representing. Any questions from committee. Seeing none without objections rules sorry we got we got a question on the representative Gonzalez you're recognized. Thank Mr continue to help people get on this list or they it's an actual conviction and then they're like a. I mean is it like the sexual. Predator list kind of thing is that we're talking about it was this in response to some legislation that was passed or something you'll just decided take upon yourselves and do it is not as a result of a of a criminal conviction for instance if you may be a provider healthcare provider that would go on the registry due to neglect that calls harm to someone it was in your chart it could be the your offense was of a sexual nature you may have had a sexual offense against the against an individual that could have been investigated by law enforcement entity external to DHS but under a true finding of the offense you would be placed on our registry in which other providers employers would be able to check that registry to determine your your application had you had a finding had you committed an offense that cost a serious issues such as of of of the talent the it allows it's a it's it's very similar again to background check everything is all said what brought this to our attention was that we had a case come up or had an individual where I think it was like ten or fifteen years ago that accidentally given a patient the wrong medication and had not documented it this is in this person was very honest out of school our and we discovered that if that person by the CNA they could have gotten off the list because existing rules because they've had a different licensure they could not get awful off the registry and actions seem fair and special because everyone will back look we saw in the adult protective protection statutes your provided for DHS to do rules to to allow someone off the list and we just a number on the rules so we're trying to catch up on that now okay thank you. All right see no further questions without objection this rule stands as review. Thank you. It's only one item J. Division of Medical Services. If you would introduce yourself and who you represent Elizabeth and Division of Medical Services miss your going to be down there for a while so I am. So I sent the new awful division medical services you're you're recognized this role I'm simply add some modifiers to comply with the national drug code billing updates it does allow for us to justice and transparency in billing and collect more rebates and it also we did some clean up while we were into the committee along just clarifies and things and clean up some language we receive no public comments on this rule and it has no financial impact. Any questions from committee. Seeing none without objection this rule stands as review. Going to item K.. I am K. is to combine this is a rule to combine our drug utilization review board and or drug review committee they are both boards that help with our pharmacy program one reviews drugs to determine any authorization criteria and utilization criteria the other one helps us establish our preferred drug list currently we have eight meetings a year and they're separate those meetings last anywhere from two to four hours apiece they're quite extensive we also have a hard time and getting membership on these boards so come by combining them because they are made up of both made up of pharmacists and physicians we're hoping to make sure we have adequate membership in reducing the I'm commitment of those members to for a two to four hour meetings once at a year. So you got no comments or questions from pharmaceutical industry yes. We do have a question representive rain you're weighing as you're recognized. Thank you Mr chair also if you could give me just a kind of an overview on what the new board would look like this far as numbers and like selection criteria things like that. Each board has a criteria that has to be met partly because the way the CMS guidelines set up especially for the drug utilization review board it's going to end up being about fifteen members or so fifteen or sixteen and we try to have a balance of physicians and pharmacists so it's a very fifty fifty matches get this much as possible and it will be posted transparently on our website as well for the pharmacy program and we're we're looking at other states of how many of them have combined that in how we set up our format and length of time hopefully. Since you thank you. I see no further questions without objection this rule stands as review. So we will move on to item L.. And miss you're recognized hi this is a role to implements the rate increase for prosthetics and orthotics and there are a couple things I want to note about this rule the first is after review with CMS the rule itself contains both pages regarding the coverage of prosthetics and orthotics as well as the rate a substantive change for this rule was only to address the rate however because we were in the state plan we did decide to do some cleanup on the coverage pages however CMS asked us to pull those because they would like to do a more in depth review of those coverage pages so today we are only presenting the rate change which is the only substantive part of the rule and this is to go to ninety percent of Medicare we did receive public comments around enteral formulas however they are not actually part of this rate review that will come later I'm with all of the DME and medical supplies were looking at each one of those systematically there's just so many codes and rates to review that we're not able to do it all at one time so this is only looking out prosthetics and orthotics we have spoken with the providers of those services they are in favor of this role they have not seen a rate increase in quite some time I want to say about twenty years so they're they're excited about this rule and if you have any questions happy to answer them. Any questions from committee. So your answer was satisfactory for all these comments that that that area was not covered in this particular bill yes Sir and we will work with those providers when we do get to the medical supply we have a lot of comments regarding other areas of medical supplies and durable medical equipment I'm in so we do anticipate having to work with providers in this area areas but the goal is to go to around ninety percent of Medicare for each one of those areas I will do individual looks at the. All right seeing no questions without objection this rule stands as review thank you. So we move on to item EM. In the west more people would do if someone else is coming down to the table. That they have to I can present and if we have any questions for them they can join you're recognized okay and item income is a packet of spots forties and it yes. So as you know we recently brought to you by the nineteen fifteen C. waiver for community employment supports the developmental disabilities waiver as well as the past waiver the nineteen fifteen be waiver to and implement some changes this brings forward the nineteen fifteen online which is the behavioral health piece of that as well as the Arkansas independent assessment manual so it's the companion to that previous plan change that we have made this is all dealing with the underlying CMS authority to do what you're gonna we're gonna talk about later which is that massive we'll packet I'm in the main changes you see here is we did update the client appeal process now they automatically get an extension of benefits and so that they don't have to call us and elects to have an extension of benefits while their appeal is pending just it continues automatically and we do allow for the independence that's meant to be conducted by telephone to to COVID we are implementing that permanently with this change and we're also adding that therapeutic community levels one in levels two and the rates and the increases for those rates and the assertive community treatment and intensive in home services are being added with this and happy to take any questions Mr rest would just add I know some of you got calls from the providers around some changes the CVS manual that will address that on autumn you that's where that comes in okay. Representative Ferguson you're recognized for a question. Yeah I guess I just have a question about the referral process and assisting in the tears I know when we first initially created the passes tier ones were not necessarily going to be put in a passes that still the case can they stay with their primary care provider and not go into a pass for treatment yes ma'am that's still accurate we still only Penzo tears two and tier three an impasse okay thank you. Okay committee any other questions on this rule. Seeing now without objection this rule stands as review thank you. Okay moving on the item in Division of County operations. So if you all would come to the table. Please introduce yourself and the represent. Under a great deal with DHS the Division of county operations. Roast page with the Division of County operations of DHS. You're recognized right this is section this is a rule change the section of the Medicaid policy manual and it's just a very simple clarification that the of fetuses considered in a medically in the medical need standard when determining eligibility it's always been true but and during a re write the manual it was eight or it was inadvertently left out it's being added back in and and then some grammar clean up in there but it's just to the main section is the Four thirty. Hey is where the meat of the new rule is and it's just a notice been added inside the policy. I'll take a note there were no public comments and there's no financial impact. Any questions from committee. Seeing none without objection this rule stands as review thank you. Okay moving on to item Division of Medical Services we might drop down and do the ones that you all are doing together so we're not going back and forth our Twitter please introduce yourself again Elizabeth Pittman Division of Medical Services. Centeno awful Division of Medical Services you're recognized to present item This is another role regarding modifiers for pharmacy check for for drugs and distance specifically is regarding three forty B. programs which are generally run to hospitals and it allows them to get drugs and through the three forty the federal funding and we are asking them to place modifiers on drugs that are procured through that three forty B. program this comes at the recommendation of the Attorney General's Medicaid fraud control units in the office of Medicaid inspector general and there were some problems with some three forty programs in this state and say they asked us to take this rule forward and we have extended the effective date under the packet size January first of twenty twenty three but due to two issues one making sure system is ready into making sure providers are ready we have decided to extend that out to April first of twenty twenty three and providers did comments on this rule primarily arounds and some difficulty in implementing it so we're asking if you hear about that from any providers and have them reach out to us directly we are working with individual providers to make sure their systems are prepared to go live with this rule. So there is a financial impact on this but it's covered under the budget is that right. There. It's it is it's going to should be a cost savings to ensure the lesser of methodology is properly applied with the use of the modifiers. Okay we're looking at a one point six million savings savings okay thank you. I would question the representative Bentley you're recognized for a question. Thank you chairman thank you all I have been hearing some concerns as well small providers on what is going to happen to them so with the with the pricing being a moving target hi we're gonna help those providers should be able to there and that you get so they're not you know then call back and and again this savings coming back to us or the I'll explain this a little bit How that's going to help housing actually help the the taxpayer and then what six planets bill to give more details on that as well minutes in the explain on how that the systems can be implemented and how we can work with providers and I mean the savings is really it's it's more off being able to I make sure that things are being built correctly there were some I'm providers that were not billing us correctly and in fact we're getting more than they should have under the three forty B. program and so that's where we're anticipating things thank you for the verification thank you. The. The the vendors for the providers that are enrolled in three forty B. have access to programs either through wholesaler's or other three forty B. pricing so that our there's pricing methodology that our system will be able to put into the system that should match what their system should be billing for if that makes sense that the ceiling price and the different prices that we get from files are loaded into our system but if there's any three forty provider who needs to dispute they would have an open channel to be able to dispute that their price is not matching what we think the maximum price should be for that that particular bill it is there's not that many vendors for three forty B. that do this so there's several conglomerates may provide those drug files pricing files to these three forty providers does that answer your question so just to clarify we're gonna have a real time pricing for them easily available for them to get to to do that correctly that you're telling me or. In a way yes ma'am the three forty B. hospitals in outpatient clinics and pharmacies that are enrolled with three forty B. have computer programs that keep their prices they know what they are for every product whether it's a pharmacy dispense product or hospital or outpatient position Mr drug product and our system will have access to those same type of files it'll be loading and there will be a way for any provider to dispute if there is something coming back and they think that that's not a correct price that Medicaid has said it should be so one must follow chairman real quick so we will have plenty of staff to make sure that we those questions are answered quickly for folks so. Yes ma'am those those claims will flag we've we've been working through many internal processes of how to handle this quickly and and responsibly for the provider thank you thank you. Representative Gonzalez you're recognized for a question. Thank Mr how many of these providers are are out there this seems like a pretty significant number of wartime one point six million for the remainder of this fiscal year two point one million next fiscal year does this Russell level of fraud are we trying to get this money back that we've overpaid what so the Attorney General and the Office of Medicaid inspector general and have investigated these cases and decided what action should or should not be taken so that they are involved in have and work on those cases I'm not sure where they are with those and can't speak to that and we're looking at you know what we could potentially save by not having the ability for providers to over bill is for those services I'm in this like I said primarily affects hospitals hospital pharmacies are the prime there are some FQHCs federal qualified health centers that also use the three forty B. program how many providers I don't know the total number do you. We have about a hundred fifty or so total providers in the state of Arkansas or surrounding states some of the border towns there's less than twenty pharmacies so it's primarily sites where there would be physician administered drugs hospital outpatient clinics like she said if you agencies in rural health centers and we've been in contact with many of them about the project as we've gone along has over building occurred in all of them across borders it just specific ones specifically thank you. All right seeing no further questions without objection this rule stands as reviewed thank you. So we'll move on to P.. So is that when you're recognized this is a role to increase our rate for long acting reversible contraceptives and we did not receive any public comments on the rule the rate goes to wholesale acquisition plus six percent I'm we have received a few questions from positions around the rates and making sure that we're staying in line with national rates I'm and we are following the north Carolina model and when we decided to to do this increase. I am happy to take any questions. Committee any questions representative version you're recognized for a question. Thank you Mr chairman yes as as a concern about infant and maternal mortality certainly one of the big things that we need to address is providing more long acting contraceptives in the comments section of why are you not changing the CPT code that was one of the comments he said it was beyond the scope of the rule but is that something that you're considering outside of this rule is changing the CPT codes and the reimbursement. I'm not sure what CPT carried fifty nine four hundred well I mean it in the comment it says it would be beneficial for CPT code fifty nine four hundred would be considered for the level increase as the scope pricing is not a change in many years it's current reimbursement is twelve ten CPT code fifty nine five ten has not been updated either so our is there a consideration to update those codes and to look at that in terms of reimbursement I will look at these code specifically when I get back in as you know we under executive order wow I can't remember the exact nineteen of two maybe a week we are looking at all Medicaid rate reimbursement so I'm sure these have been or will be looked at but I will pull them and make sure yeah I mean I committee for the increase in the pay rate but that doesn't do any good if the CPT code doesn't align I mean we are increasing all I don't know what CPT code this is but we I'm actually cover all and. Larks to my knowledge. That is global billing for obstetrics someone texted me into Williams which items that would actually I'm not be covered under this well that is correct and yes we are looking at that as part of specialty position well it And as I've talked to mark and people at for ten years about I have a real concern about global billing what we find locally we lost to obey because of global billing because they would follow the patient throughout their prenatal care they when they got late ready to deliver they wouldn't drive the thirty minutes for city or to desoto Memphis but they would call an ambulance to go to the med in the end the OB got paid nothing for the OB care for all that term with us you know pregnancy so I really I really hope you will look at the global billing it's a real concern for for us we are looking at that as part of what we're doing especially physician may review right. Any other questions from committee. Seeing none without objection this rule stands as reviews. So now we're we're gonna skip down we're gonna skip on down so we're not playing musical chairs here which are open yes but I'm I'll I can handle that this next one the next one for item or I can handle that one yep Committee item Q. has been pulled down so we're down the item are. So you're you're recognized by mistrust what I've been reported to you do all counsel each month on this ofschool and and handle this one this is the rule change to implement the rate increase for assisted living services and this is something that you often special language and directness to work towards this retained to continue to to work to get that done I think the providers are on board everyone's happy with the rate we set we've answered CMS questions as of this point we're just waiting for a CMS approval based on the question we got from CMS so far I'm not anticipating them to raise any objections to it was waiting to get that finalized and so we will hold off filing this rule and so we had that seems for will and certainly have seen Mr Manson changes will bring this back to you and that be happy to answer questions. Any questions from committee. Seeing none without objection this rule stands as review. So item S. has been pulled down. So we'll go to item T. Division of Medical Services again you're recognized yes at this rule and ends the cycle of reconciliation for the primary care case management program it aligns it with what we do and the PCMH program for quarterly reviews and reconciliations and this has no financial impact we receive no public comments in the primary driver of this rule is a legislative audit finding I because we were not timely doing those reconciliations and said this will put us in compliance that that timing cycle. The questions from committee. Seeing none without objection this rule stands as review. So we'll move on to item you. Mr if I may all other matters themselves and I'll just some brief comments on this one all of them to summarize the rule I could. Interest again deputy director division of aging adult Meryl Health Services. Cholistan Arkansas department of Human Services division of medical services. Good morning Melissa whether ten division director for developmental disability services Department of Human Services. You're recognized to present thank you Mr chairman so I know many of you are aware of the task force that I represent Vaught has been leading to work towards changes around behavioral health system it is been a significant effort and I will see how much I appreciate Rizzo Vaught a version Cavenaugh a reserve eleven I started naming names operate shouldn't have because all forget some but just so many legislators who provided such great leadership through this task force to pull providers together to pull us in as a department and to work through this to find some find some past four to some good changes and some good transformation that is needed so I want to say thank you to the legislators who've been part of this process I know some of you may have got calls from the deep providers around one specific piece of this around the C. S. manual we've talked to them they were standard they are in support of the general thrust of we're going on that one piece there's some issues with some of the details so we pull that piece out and from what I understand I think that's they're satisfied with that so that that part is taken care of the remainder the rule I think it's something this month I have not been deep in the negotiations on this but I think it's fair to say that while not everyone is super excited about this is something that everyone can live with and make some real improvements for us so with that said all for to our folks to walk through specifics and explain that to you. You morning today we present for review nine manuals and related state plan amendment pages these manuals amendments and acts in admins and the repeals are focused on shifting away from the fee for service methodology and moving toward the team based provision of services thus lessening the administrative burden on providers supporting the efficient use of current work force and adding additional licensure is to increase the availability of services. And raising the quality of care with the implementation of evidence based and professionally recognized service models including assertive community treatment and intensive in home services. There were multiple public comments during our period and when we were out for public comment and there were rule changes that were made based on these public comments. The biggest of these changes was a reorganization of the client services supports provider manual to make things more clear and to clarify the settings rolls around a service called rehab day service which is a facility by service but individuals do not remain there overnight so does for the team as significant changes that we made to this manual but we're happy to address any other questions you may have. Are there any questions from committee. Representive when you're recognized for a question. Thank you Mr chair so I had one question just regarding and I'm not sure if this was part of the part that is gone or as part of the part that still remains but the the what assurances do we have that if I'm right there was required about twenty four hours that no longer now you know in order to be able to receive that you have to be open twenty four hours do we have assurances that there will be providers still that will be answering around the clock rather than just the nine to five. So I am absolutely so one of the manuals that we have is the independently licensed practitioner certification manual so I think that's probably what you're referring to is that we have to pull that meant that certification manual down however across the services are available twenty four hours three multiple there through our agencies they nine eight eight we across the services that are available and as a licensed professional I'm ethically required to respond and to be responsible clinically for any client that I have. Is there any extra incentive for those who do have twenty four hour services I mean is there a different billing rate or is there anything in use you know the three AM call is very different than a three PM call. And there is no differential for those who have this twenty four hour calls we do have our twelve community mental health centers and they are required under contract with us to provide twenty four hour seven day three hundred and sixty four days a year coverage of crosses Services for populations so we do have that under our community mental health center contracts. Originally if I just add cross response is certainly is a critical issue so I don't want to think that the work is finished here we know there's a lot more these we don't have process response to nine Tuesday will be dismissing this can work around that in the coming months and I assume we'll have data that we can discuss I mean obviously with if we do see an unforeseen drop off we can we can adjust and and meet those needs at any time. Absolutely great thank you very much thank you for your to. Any other questions from committee. Mr Jole. When read knew that pronounce that right. did you have some comments. Yes. Please have a seat there in. It. Introduce yourself and who you represent. Thank you Mr chair my name is Joel lander NO I am the executive director of the behavioral health council the Arkansas cancel behavioral health we are a trade association of twenty three behavioral health providers consisting of private for profits private non profits and community mental health centers we have worked quite extensively with DHS on the package of rule changes that or before you for review and item you. it was ten menus looks like a pull down one of them so DHS has been engaged in conversations with us and other providers going back to probably this spring time well before anything got published for public comment and so DHS had made a number of changes to their initial proposals that accommodated the concerns that we made known to them in those early conversations and in fact even with the public the published a draft that will got put out for comment in October we had some pretty serious concerns about them that the DHS did continue to address and in fact as recently as Thursday of last week representatives of DHS were in council meetings editing and revising the draft as we were still raising concerns so I want to say all of that to say that my comments or and a call for for caution and observation but not opposition if they I haven't seen the draft that they put together Act before Thursday's want to one PM deadline that they had to submit to BLS but if they if they made those changes then I won't be here at rules and rags squawking about about the rules but there are some concerns and there are three in particular that I wanted to make known to the committee and I think that they're watching you kind of touched on one of them and and that is the repeal of the independent licensed practitioner main. Up we have like most employers have had a difficult time staffing our our business is it for whatever reason it's difficult to hire it post code is made it even worse and so we are very concerned about the incentives around. Behavioral health practitioners and who work for. we think we're concerned that the incentives or to leave behavioral health agencies and set up independent practices and of for a variety of reasons one is the pay is the same the oversight is less and it's about to get even the last with the repeal of the IOP manual by this is most acutely felt in the requirement that is currently in place for independent practitioners to be available twenty four hours a day for emergencies for their patients. We in the process of these promulgation as we've heard from Iraqis who are celebrating the repeal of this manual of course. Civically they're celebrating not having to answer the phone after five PM and our concern is that those patients are going to need to be addressed somewhere if the IOP doesn't handle a call then that becomes an E. R. presentation perhaps or it becomes a mobile crisis call for the community mental health centers up missed gan is correct in saying that we would be there to handle those and we are under contract to handle those but to relieve the aisle piece of that requirement seems to me to be changing the obligations imposed on community mental health centers without changing the compensation they're there for. And so we were concerned about whether or not there's gonna be a spike for one thing handling an emergency would best be done by the people who are most familiar with that patient's situation so for continuity of care purposes we think it makes sense to have a mechanism that requires that independent practitioners respond to the emergencies for their own patients but also it creates is another reason to leave agencies you know I don't want to be interrupted at five PM because it's dinnertime so you know working for an agency something that requires that so. The staffing incentives are already against us we believe and we think this adds to that so if that would be a way to compensate for the additional burden that would certainly help and we have made that point over and over again with VHS we haven't gotten anywhere with those consultations to date so I do believe that it bears watching to see what kinds of burdens are imposed on the community mental health centers which are the public safety net for mental health but then so is Medicaid and so I don't think it's unreasonable to ask for Medicaid practitioners to also participate in providing that that safety net. This that's the IOP manual issue the second of the three issues that I've got that I want to speak to you today is the process for making the transition from behavioral health agency to CSS pee I don't think I'm confused about that but I do have members that are and I think the DHS needs to step up its game in explaining how that transition will be made what will be required of the providers to to transition that was one of the issues we were typing on Thursday making revisions to it because they had made a provision that to do adult rehab day you had to be a CISSP enhanced but they didn't have a mechanism to transition from behavior health agency to CSS be enhanced they fix that I think and so it looks like that won't be an issue But the big issue with CSS CSS be enhanced and adult a rehab was the facility requirements that they were imposing CISSP enhanced includes your residential type programs where plants live there twenty four hours a day deputy communities community reintegration that kind of thing there are agencies that do only determined or adult a rehab these are programs where the adults could be in the office forty six hours a day but they don't live there and because they were being imposed up to included in CSS be enhanced they were being required to meet that level of facilities requirement which had prescriptions for bedroom space and and and and that kind of thing they fix that they did say they were going to fix it before the public manual but it didn't get done until after after we had the commentary but that DHS was responsible to that as well the third and final issue I want to make known is it's difficult for us to plan our businesses without really knowing what the rates are going to be for some of the services and the real reason I wanted to come here today was to speak about a proposal that they have made to reduce the group therapy rates which is how a lot of our agencies pay for the more expensive and involved services for those clients who have higher needs DHS has a plan in this manual to provide a new service called assertive community treatment teams these would be professionally led treatment treatment teams that focus on high needs clients. That would have a special rate which is still a mystery we don't know what but that would Beck and whether or not you can economically feasible to provide this service but when we raised concerns about the cut in the group rate we were told that the ACT teams or the way that the agencies could provide a higher level of service and receive a higher level of of revenue up without knowing the specifics on that it's difficult to be able to say that is that that one replaces the other there is a proposal to also to increase individual therapy rates but we believe that in many of our agencies that's more than offset by the cut in the group rate so I've we would urge of a delay in the plan to cut the group rates which I'm told from miscanthus not actually on the agenda today but it's part of the conversation this is part of the context of the CISSP manual the creation of the S. eight ACT teams and how long it would take to implement that we don't think that's going to happen immediately I think this manual is set to go into effect January one obviously everything won't be up and running by January one so we we we do believe there's gonna be a need for a period of time for transition and we would like the group rate cut to be delayed until that can occur and so with those three points I believe those that that does conclude my remarks and not be welcome to take any questions you have. Yeah I think we do have a question representative when you're recognized. Thank you Mister chair I was when I was looking at the the header here on the agenda it says lessening the administrative burden on providers a jewel while you're up there and and if anybody else has any comment on how are we lessening the administrative burden do you feel like it's being lessened I do not The introductory statement that was given to you for the context of these rules sounds very appealing we favor a move away from fee for service we favor evidence based practices implementation and I think they're talking about ACT teams when they say that but it's again not clear that that that's going to happen what we the way we feel today is that we have the same criminal fee for service system that we had with Medicaid being the primary pay are except that we're having to do with five P. orders instead of one so we have five pay or is to have to credential are professionals with and each of those has a different process we have five different pay or is that have different policies on authorizations some requiring some don't some are more prone to reject some parks the complexity has only increased since the implementation of past and that's why we are hoping to implement a system where we would have. A nationally recognized model with a what would you pay for capacity we're not being tick tick tick on every authorization and approval or denial but you would pay for it prospectively a team of professionals that could provide X. number of services and we know how much revenue we have to do with and we know how much we could pay so that we could pay an LCSW who has ten years experience a higher salary than somebody coming right out of school because you want somebody with more experience seeing those patients with higher needs and those of the patients we have in agencies have so we think there needs to be a way to incentivize those people to work for us and not incentivize them to go out in private practice and take it easy because it's not easy working for an agency but we recognize that I don't think these rules go there and Act I'm DHS tells us they want to go in that direction and we would welcome it I'm at I have a fourteen point anywhere in these manuals that actually is the case. Any thoughts on that. So just just from a chart perspective because all of that has been talked about primarily from adult perspective the group piece of this as well as the the assertive community treatment for adults with serious mental illness so just to give some context or thirty five thousand children there in the past there about ten thousand adults in the past just want to talk about some of the changes that were made so we we do believe that we have made changes in this manual that allow for home and community based services so we know for children that's called intensive in home. And so that that service has been placed in the manual we have some providers that can provide that service in this is the services keeps children in our home communities it as the lead by professional which for service that professional oversight that is a team of professionals I and it is an evidence based practice so we've added that we've added ACT so I think our goal in all of this is to make sure that we have we're leaving that medical model which relies heavily so heavily on the provision of professional services by delivered by councillor. The individual therapy sessions this therapy sessions those kinds of therapy sessions and really moves us and this is the next step in moving us towards that kind of system where we have and services that are in home community settings and so this rule beyond what what Joel has spoken about has also included some services even at a lower level that are some services like respite so some things that are going to keep people in their home and community settings that again don't require professional doesn't require professional oversight and have new providers that can bring those so that is one of our goals across is to make sure that we have all the services available to individuals particularly those in the past. I would hide I think it's important you know as we've enjoyed working with Joel and making a bunch of changes and I appreciate being recognized and that we being recognized for that effort the task force as mark and mention the beginning represented all provider types and I think it's important to remember that that Mr Lanzarote represents one type of provider in this space but is miss down mention there's a whole bunch of children that we serve under the pass and there's also a whole population of people with intellectual disabilities and so we are looking at a broader perspective on some of this and I think individual provider types are looking at under the leadership of represented by and Cavenaugh which we really appreciate. Thank you. Representative ray you're recognized for a question. Thank you Mr chair Joe you had mentioned that the I. L. P. manual when it's you know repealed that the oversight goes away so I just want to is there oversight I'm guessing the new CSS P. manual that it's kind of replaces the oversight and that IOP. Represent great thank you for the question I don't believe that would apply to appease the CSS P. manual would only cover those agencies that are licensed as a CSS please what does Miskin told you in her opening statement was that the aisle Iraqis have ethical obligations that they owed to their licensing boards and that the enforcement mechanism would live with those boards and not with the DHS so DHS itself has an enforcement mechanism now to enforce a twenty four hour emergency call with and can practitioners that they would no longer have if the repeal is this goes there. Okay thank you so at essentially the board would their respective licensing board with the written reply to us as I can that's a that's a licensing board issue okay thank you. All right. See no more questions thank you for your input. Thank you Mr chairman seeing no more questions without objection this rule stands as review thank you. All right moving on to item and the. You're recognized yes at this is very excitingly the life three sixty home rule that goes with our home. The our home at extension waivers CMS has approved us to move forward on like three sixty homes I'm in this will actually implements that inputs those into place that includes both the maternal all the maternal line three sixty on the and successfully three sixty home and the rule life three sixty home as you know we wanted to target those three populations women with high risk pregnancies I'm for that group this actually does expand it beyond just the our home population to all women with high risk pregnancies in Arkansas Medicaid we also we're covering and the rule life three sixty have which is for individuals in rural areas with serious mental illness or substance use disorder and then the life three sixty six as homes I'm which are for use at they range anywhere from nineteen to thirty I'm in there and groups that are considered high risk for continued poverty and continued reliance on social services so groups like former foster youth former DYS involved and the primary public comments we received were regarding that PMP for the maternal like to sixty home and whether or not those are sufficient we have not we have a budget neutrality target was CMS but it's an aggregate across the entire program so we're looking at that rate in relation to that budget neutrality target just to make sure that it is sufficient for those providers and we're working with our actuaries and with our providers on that and then we also had to have two letters of intent already so you have to act hospitals that have agreed to be maternal life three sixty homes are before process so happy to take any any questions. The questions from committee. Seeing none without objection this rule stands as review just before I finish on that one thank you to everyone who works on the life three sixty homes I know at. Representative Greg was very instrumental in getting these and and represent Ladyman you've also served on that committee said thank you for your support it was very exciting we're looking for this. Okay moving on to W. item W.. And this is the last time you have to hear from me today. This is I'm actually Division of County operations role to expands I'm pregnant women's coverage for women in Medicaid right now we have two groups of pregnant women one called full pregnant women and they receive all medical service benefits are not just benefits related to the pregnancy but for any medical condition that they might have during their pregnancy in the two months after and we have another group called limited pregnant women's they receive only medical services related to the pregnancy what this role will do is move that limited pregnant women's and group into the full pregnant women's benefit and so everyone will receive full medical coverage for the duration of the pregnancy. Any questions from committee. Seeing none without objection this rule stands as review thank you thank you for your time today. Okay moving on the item X.. The county operations. Please introduce yourself maybe represent. I'm sorry Crutchfield Division of County operations with the H. S.. Road page Division of County operations with DHS you're recognized right this is a rule to change coverage primaries for former foster care children with the new federal requirements from the children's bureau foster care coverage should be available to individuals that age out of foster care and move from one state to another this only applies to use to reach reach age eighteen up on or after January one twenty twenty three basically the rule says that if you come to our state I having aged out in another state will cover you if you leave our state after you age out and go to another state they'll cover you that substantially this the rule and it's not No there there's no financial impact or no comments. Any questions from committee. Seeing none without objection this rule stands as review thank you. With item one. Mr we save the best for last. Well run the letters the use of it. Please introduce yourself and who you represent. Thank you Mr chair good morning Martinez Smith division of provided services and quality assurance you're recognized thank you I presented a rule this morning regarding the revisions to the certified nursing assistant or CNA a rule manuals I'll tell you that we worked with the workgroup when we revise these rules that work group consisted of representation from the two different associations of the industry was also represented and one college was represented in those meetings out of that meeting the revisions that we have to this manual include adding virtual instruction to the CNA program so that these students can receive some of their lessons virtually and then also we clarify some of the rules regarding age if you are a military member or a spouse or a veteran of how you can gain licensure in the state of Arkansas we also updated some terminology some of it was outdated and made a few clarifications in the manual as well I'll add that we had no public comments for this rule but we did have a few questions from BLR and we did answer those questions I'll answer any questions thank you. Any questions from committee. Seeing none are without objection this rule stands is reviewed thank you very much. so this last item we approved a lot of rules today I'm anxious to see you know how this improves our medical standing within the state and looking forward to our homes thanks general a lot of important things to come here today so we appreciate your to dos time in incorporation of this man thank you. With that we are adjourn.